Meyer zum Büschenfelde K H
I. Med. Klinik und Poliklinik, Johannes Gutenberg-Universität, Mainz.
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1990:1225-9.
Bile duct stones can be treated by conventional operative endoscopy in up to 90%. Stones with a diameter of up to 10 mm may be treated without endoscopic sphincterotomy (EST), larger stones require EST and subsequent mechanical lithotripsy. Extracorporeally generated shock-wave lithotripsy (ESWL) is indicated in huge (phi greater than 15 mm), hard, and intrahepatic calculi. High risk patients are palliatively treated with transpapillary stent. Symptomatic gallbladder stones require surgical therapy in up to 85%. Only selected patients are candidates for oral litholytic therapy (phi less than 10 mm) or ESWL (1-3 radiolucent stones, phi 10-30 mm). Percutaneous transhepatic litholysis is not yet established as therapeutic alternative.
胆管结石采用传统手术内镜治疗的成功率可达90%。直径达10毫米的结石可不进行内镜括约肌切开术（EST），较大结石则需要EST及后续机械碎石术。体外冲击波碎石术（ESWL）适用于巨大（直径大于15毫米）、坚硬的肝内结石。高危患者采用经乳头支架进行姑息治疗。有症状的胆囊结石采用手术治疗的比例高达85%。只有部分患者适合口服溶石疗法（直径小于10毫米）或ESWL（1 - 3个透X线结石，直径10 - 30毫米）。经皮肝穿刺溶石术尚未成为一种可供选择的治疗方法。
